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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(05): 621-627
DOI: 10.1055/s-0041-1729941
Artigo de Atualização
Infectologia

Infecção após artroplastia total primária de joelho: estudo randomizado prospectivo controlado da adição de antibiótico ao cimento ósseo[*]

Article in several languages: português | English
Hugo Alexandre de Araujo Barros Cobra 
1   Centro de Atenção Especializada em Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
Alan de Paula Mozella 
1   Centro de Atenção Especializada em Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
Pedro José Labronici 
2   Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
,
Amanda S. Cavalcanti    *
3   Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
João Antonio Matheus Guimarães 
3   Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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Resumo

Objetivo O presente estudo prospectivo, randomizado e controlado foi realizado com 286 pacientes submetidos à artroplastia total primária do joelho (ATJ) com o objetivo de avaliar a eficácia da adição de antibiótico ao cimento ósseo como forma de prevenção da infecção pós-artroplastia (IPA).

Métodos Os pacientes foram randomizados em dois grupos: cimento ósseo sem antibiótico (Sem ATB, n = 158) ou cimento com antibiótico (Com ATB, n = 128), ao qual foram adicionados 2 g de Vancomicina para 40 g de cimento. Os pacientes foram acompanhados por 24 meses após a cirurgia.

Resultados No que diz respeito aos dados demográficos pré-operatórios, a distribuição dos pacientes entre os grupos foi homogênea (p < 0,05). No período de 24 meses, a taxa global de infecção foi de 2,09% (6/286), não havendo diferença (odds ratio [OR] = 1,636; intervalo de confiança [IC] 95%: 0,294–9,080; p = 0,694) entre o grupo Com ATB (1,56%; 2/128) e Sem ATB (2,53%; 4/158). No grupo Sem ATB, a infecção foi causada por Staphylococcus aureus resistente à meticilina (MRSA, na sigla em inglês) (n = 2), S. aureus sensível à meticilina (MSSA, na sigla em inglês) (n = 1) e Eschirichia coli (n = 1). Proteus mirabilis e MSSA foram isolados dos pacientes do grupo Com ATB. Dentre as comorbidades, todos os pacientes com IPA eram hipertensos e não diabéticos. Dois pacientes com artrite reumatoide que desenvolveram IPA eram do grupo Com ATB.

Conclusão O uso de cimento com ATB reduziu o número absoluto de infecções; porém, sem diferença estatística entre os grupos. Desta forma, o uso rotineiro não deve ser encorajado.

Palavras-chave

antibiótico - artroplastia do joelho - cimentos ósseos - infecções relacionadas à prótese

* Trabalho desenvolvido no Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.


Supplementary Material



Publication History

Received: 27 July 2020

Accepted: 01 December 2020

Article published online:
28 October 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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